2021 Volume 41 Issue 5 Pages 383-386
A 73-year-old man with thalamic pain after right thalamic hemorrhage was urgently hospitalized for massive melena. Upper gastrointestinal endoscopy and colonoscopy showed no active bleeding. Emergency double-balloon small intestine endoscopy showed multiple erosions, which were judged as representing nonsteroidal anti-inflammatory drug-induced mucosal damage, but the source of the bleeding could not be identified. No extravasation was identified on abdominal contrast-enhanced CT. The melena subsided at first, and the patient was watched closely in the intensive care unit. However, 2 hours later, the patient developed massive melena again, resulting in hemorrhagic shock, and emergency laparotomy was performed. Intraoperatively, no obvious abnormalities were found on the serosal side of the small intestine. When the endoscope was inserted from the incision site of the jejunum, which was 20 cm aborad to the ligament of Treitz, massive occult blood was observed in the bowel segment extending from 20 cm to 100 cm aborad to the ligament of Treitz. Therefore, partial resection of the jejunum was performed, following which the hemodynamic status promptly stabilized. Histopathological examination of the resected specimen revealed a ruptured dilated artery protruding from the mucosal defect, which was diagnosed as a jejunal Dieulafoy’s lesion.
